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Adolescent Depression :Much Catching Up To Do
Some believed that the hormonal changes, integral to the maturation process, were responsible for the emotional roller coaster of the adolescent period. That period of the life cycle was believed to be characterized by confusion and the subsequent "acting out" or acting "withdrawn". There was not much thought given to the possibility of depression as an additional variable impacting youths. This basic determination was the adult explanation for the mental, emotional, and physical changes accompanying a youth into their young adult years. According to the National Institute of Mental Health (NIMH), it has only been in the past two decades that depression in children has been taken seriously. Although, that which is known about depression in adults is far ahead of the knowledge base about depression in adolescents. There is much catching up to do but the gap is closing quickly. It is known that there is an overlap in the symptoms expressed in adults who are depressed and young persons who are depressed. With adolescents, as well as with adults, the first step in diagnosing depression is to rule out any physical condition that might account for the symptoms by having a complete physical performed by the pediatrician or family doctor. If there are no physical findings to account for the behavior and disposition concerns, an evaluation by a psychiatrist who specializes in the treatment of children and/or adolescents is the next step. After evaluation, the psychiatrist will likely recommend a psychologist or social worker to manage the psychotherapy while the psychiatrist will manage the medication aspect of treatment, if medication is thought to be an effective part of the treatment approach. Each child and adolescent is unique in his or her characteristics and behaviors. Each is unique in the way he or she progresses through the various stages of the life cycle. The home and school environment is also uniquely experienced by each individual. A well qualified health care professional is best suited to diagnose and suggest a treatment plan for the youth who is believed to be depressed. Parents should ask questions before committing to treatment for their children: * What are the therapist's qualifications? * What kind of therapy will the child have? * Will the family participate in the therapy? * Will the child's therapy include medications such as an antidepressant? * What might the side effects of any medication recommended? * What are the specific treatment goals? * Approximately how long will treatment last? Some of the concerns seen in adolescents who are depressed represent a stable pattern of behavior. The depressed youth may pretend to be sick or may refuse to go to school. The depressed youth might cling to parents and worry excessively that the parent might die. Older children or adolescents might sulk, get into trouble at school, be negative or grouchy according to the NIMH. The depressed adolescent can be rebellious and feel misunderstood. The degree and persistence of the above symptoms are indicators of stage-related behaviors or signs of depression. Determining the more severe type of depression in both age groups (children and adolescents) is far easier than determining more mild types of depression. Mood fluctuations have been an acceptable aspect of life and a decrease in the mood level - feeling down, off, disorganized, on overload, etc. - are part of the everyday vocabulary of this time. No one would give a second thought beyond asking an individual uttering one of the above complaints a question like "What's wrong?" And it is true that feeling down or blue is often a normal response to situations that confront us daily. But there are questions about the personality types, the genetic vulnerability, past traumatic events, and the way different people deal with everyday confrontations that shut some people down and motivate others to solve the situation and move ahead. There is something to be said about the trials and tribulations of the passage from childhood to adulthood but the stormy aspects of adolescence do not usually endure through long periods of time and do not leave a path of destruction in the individual's life. There are issues, they are resolved or forgotten, and life goes on until the next set of challenging circumstances occurs. Sir Michael Rutter, a child psychiatrist, who has researched issues with adolescents for decades, wrote "It is evident that normal adolescence is not characterized by storm, stress, and disturbance. Most young people go through their teenage years without significant emotional or behavioral problems. ...there are challenges to be met, adaptations to be made, and stresses to be coped with. However, these do not all arise at the same time and most adolescents deal with these issues without undue disturbance." (1) There are so many variables changing the fabric of the complexity of life. The individual at any stage of development is influenced by parents, parenting skills, varying parenting styles, socio-economic factors, self-esteem, self-confidence, peer approval, physical characteristics, genetic vulnerability, etc. The list goes on and on but the important point here is that a context is imperative in understanding and diagnosing mild depression in adolescents. For example, a child might need glasses to improve eyesight in order to excel in academics or athletics. The vision problem might go undetected by teachers and parents. The desire to participate in sports and the inability to do so might frustrate and eventually isolate a youth from his or her peer group of choice. Subsequently, self-esteem and self can be damaged and the young person might become more socially comfortable with a peer group that is undesirable. Thought patterns are becoming altered and probably negative. Self-confidence and self-esteem will diminish even more with negative beliefs about the self and the world. In adolescence, peer acceptance is important and functioning with an undesirable peer group leads an adolescent with low self-esteem to act in ways that block him or her from realizing and developing a true identity. Confusion ensues and the result will likely be feeling down or depressed, rebellious, and difficult. The main point here is there are factors that can influence a young person onto a path where more and more build-up of undesirable influences find their way into a young life. It is important that the adults caring for children and adolescents are aware of factors that might be difficult to detect. Regular check-ups with a pediatrician or family doctor will familiarize the health care professional with the youth and make problem detection more possible.
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